Examining Global Trends of Adolescent Pregnancy

Examining Global Trends of Adolescent
Pregnancy: Strategies to Ensure Healthy Sexual
Development
Presenters
Mary E. Dillon, MSW, Ed.D.
Adjunct Professor
University of Central Florida School of Social Work
Andrew L. Cherry, DSW, ACSW
Oklahoma Endowed Professor of Mental Health
University of Oklahoma Anne and Henry Zarrow School
of Social Work Tulsa
1
(From Bertrand Russell, A History of Western Philosophy,
1954, pp. xiii, 836)
The conception of life and the world, which we
call “philosophical” are a product of two
factors: one, inherited religious and ethical
concepts; the other, the sort of investigation
which may be called “scientific.” “One of the
few unifying forces is scientific truthfulness,
by which I mean the habit of basing our beliefs
upon observations and inferences as
impersonal, and as much divested of local and
temperamental bias, as is possible for human
beings.”
2
Global Trends of Adolescent Pregnancy in the 21st
Century: Implications for Social Work Education
• Our students need to know that adolescent pregnancy is a
problem in our society because it is a cultural prism.
• It exposes a spectrum of harmful sexual and reproductive
health issues that are failing adolescents and us as a
society.
• Adolescent pregnancy is an issue that will be a major
health concerns in the 21st century.
• Not just because of physiological or developmental health
issues but because adolescent pregnancy is a social
construct of reality that is described as a problem for the
adolescent mother, her child(ren), and the state as a
governing political and economic body.
3
Global Trends of Adolescent
st
Pregnancy in the 21 Century
• Under most prevailing social systems,
policies that control the sexual and
reproductive health of girls and women are
sustained because they are promoted as
being in the best interest of the social order
and the state (Stephens, 2004).
4
Is Adolescent Pregnancy a Choice?
• Adolescent pregnancy goes far beyond the choices
made by adolescent girls; it is a phenomenon that is
more associated with structural factors such as the level
of national and community wealth and poverty (social
capital), conservative tradition and culture, religion,
and the political environment.
• Based on scientific studies, what becomes evident
when examining adolescent pregnancy at the global
level, there are three distinct groups of girls who
experience pregnancy in very different ways.
• The World Health Organization (WHO) defines girls
between 10 and 19 years old as adolescents and are
from countries that are described by the United Nations
as developed, developing, and least developed
countries.
5
Global Adolescent Sexual Health
• When looking at the reproductive health of adolescents,
grouping countries by their stage of economic
development has many advantages in studying adolescent
pregnancy and childbirth. For one, some 70% of teen
births around the world are among girl’s living in
developing countries.
• In developing countries, where health care is more
available, the situation may be quite different. The focus
in these countries may be on some aspects of providing
adequate medical and social services to reduce adolescent
maternal and child risks.
6
Teen Pregnancy in Developed Countries
• In developed countries, issues related to adolescent pregnancy
are not typically about limited resources to meet the national
challenge of adolescent pregnancy.
• Here the debate centers on what sexual and reproductive health
services that can be provided to adolescents without
encouraging higher rates of adolescent pregnancy.
• This becomes a conundrum when you are pitting health services
against politics and religion.
• In some developed countries, questions about public sexual
education and the degree to which contraception should be
available to adolescents can quickly turn into a raging debate
over how young is too young for sexual education and
contraception?
7
The Greatest Risks of Adolescent Pregnancy
• The greatest risks for an adolescent mother and her child is
delaying or failing to receive prenatal care, and the social
and political response to her pregnancy.
• These are critical issues in all countries, even in developed
countries. In developed countries such as the U.S., when
pregnant teen are not using prenatal care, the reasons are
not related to the lack of available prenatal services, but
with the adolescent’s lack of knowledge and the
humiliation girls must deal with before asking for prenatal
care.
8
The Greatest Risks of Adolescent Pregnancy
(cont’d)
• In the U.S., some 85% of teen pregnancies are unplanned and
72% receive no prenatal care at all. This is a irrefutable crisis
among U.S. teen moms and their children; a crisis that everyone
acknowledges and also agrees that it requires a strong public
response.
• On an intellectual level, there also is agreement that the medical
costs related to mothers who do not receive prenatal care far
exceed the cost of providing prenatal care.
• This begs the question, why are so few pregnant teens receiving
prenatal care since there are a number of good professional
options available to increase the use of prenatal care among
adolescents. What is lacking is a widespread and visible public
education campaign in and out of schools.
9
The Greatest Risks of Adolescent Pregnancy
(cont’d)
•
•
•
•
In today’s virtual world, one way to provide healthy
reproductive education to adolescent girls is to employ social
media in a public campaign that could significantly increase
teen use of prenatal care.
Knowing that it is possible to increase utilization, the question
is why are there no public campaigns to increase use in the
U.S.?
The answer may be framed as a moral issue rather than a
medical issue. Even if programs such as Abstinence programs
worked, the only thing it would reduce was the rate of
adolescent pregnancy, but not the number of teens who do not
receive prenatal care.
Unfortunately, the human toll from the lack of prenatal would
continue.
10
Brief History of Adolescent Pregnancy
• During the 1950’s, teen pregnancy in the United States became
one of the few social issues that virtually everyone could agree
on…it was a symbol of the deteriorating state of national
morality.
• At this particular time, adolescent pregnancy was viewed as an
individual moral transgression that inflicted harm upon the
society at large; therefore it was difficult to try and implement
policy and programming to reduce the behavior.
• In today’s society, using a failed model based upon a vague
moral standard to deliver prevention services typically results in
inadequate availability of reproductive and contraceptive health
services.
11
Consequences of the Lack of Education
• Even in light of a decades-long decline in adolescent
pregnancy worldwide, much of the professional literature
and almost all of the religious and political rhetoric
continues to define adolescent pregnancy as a behavioral
problem.
• If we base our assumptions on unwed sexual behavior as a
moral transgression, how will these failed approaches serve
society or the individual in the 21st century? This way of
thinking will make it impossible to identify and develop
programming to improve the sexual and reproductive health
of adolescent girls, boys, and women of childbearing age.
12
Consequences of the lack of Education
(cont’d)
• In addition to adolescent pregnancy, young girls in the
U.S. are at high risk for sexually transmitted infections
(STI’s)---including HIV and AIDS---and other sexually
related problem.
• Why? In large part it is because national sexual education
policy does not require programmatic and accurate sexual
education in our schools.
• When researching adolescent pregnancy worldwide, it was
not surprising that U.S. adolescents have some of the
highest rates of STI’s, pregnancy, childbirth, and abortion
among all developed and many developing nations.
13
Women Lack Adequate Control Over
Their Own Reproductive Decisions.
• Why the high rates of Adolescent Pregnancy?
• Adolescent girls and young women typically lack
adequate control over their own reproductive decisions.
• If an adolescent mother is expected to lower her health
burden, she must be educated about the health and
psychosocial implications of adolescent pregnancy and
to become empowered by the state to protect herself and
her child’s wellbeing.
• This said, it is our belief that all young girls and
adolescents have an inalienable right to comprehensive
education regarding their reproductive health
14
Adolescent Pregnancy Rates Worldwide
• Even in light of a decades-long decline in adolescent
pregnancy worldwide, much of the professional literature
and almost all of the religious and political rhetoric
continues to define adolescent pregnancy as a behavioral
problems.
• This attitude is a failed approach that will not serve society
or the individual in the 21st century.
• Consequently, when the magnitude and effect of
adolescent pregnancy on the individual and community is
based on the assumption that unwed sexual behavior
among teens is a moral transgression, it will be impossible
to identify and develop programming to improve the
sexual and reproductive health of adolescent girls, boys,
and women of child bearing age.
15
Adolescent Pregnancy:
A Social Construct
• Adolescent pregnancy, as it is socially constructed in
Western culture, has spawned an industry of its own. In
developed countries, even as the numbers of adolescent
pregnancy drop, adolescent pregnancy prevention
organizations continue to dramatize the “problem” and
raise money to support their mission—a mission, which
supports a vast national and local bureaucracy.
• As a global industry, Western prevention and
intervention programs for teen pregnancy are the staple
of an international cadre of workers who require vast
sums of money to promote Western solutions in
developing and the least developed nations.
Average annual rate of population change for the world and
the major development groups
Birth rates for women aged 15–19: United
States, 1940–2010, and by age, 1960–2010
NOTE: Data for 2010 are preliminary.
SOURCE: CDC/NCHS, National Vital Statistics System
Decline in Teen Births
• Fewer babies were born to teenagers in 2010
than in any year since the mid-1940s.
• The number of babies born to women aged 15–
19 was 367,752 in 2010, a 10-percent decline
from 2009 (409,802), and the fewest reported
in more than 60 years (322,380 in 1946).
• The 2010 total of births to teenagers was 43
percent lower than the peak recorded in 1970
(644,708).
This map shows births among adolescent girls 15 to 19
years old as a percentage of total births between
2000 and 2010.
Childhood Conditions Correlated with
Teen Pregnancy
• Over the years research findings about the influence of
family, and especially parental influences on the risk of
adolescents becoming pregnant has been very consistent..
• Parent/child closeness or connectedness,
• Parental supervision or regulation of children’s activities, and
• Parents’ values against teen intercourse (or unprotected
intercourse) decrease the risk of adolescent pregnancy.
• Residing in disorganized/dangerous neighborhoods
• Being born into a lower SES family,
• Living with a single parent,
• Having older sexually active siblings or pregnant/parenting
teenage sisters.
• Being a victim of sexual abuse
• All place teens at elevated risk of adolescent pregnancy.
A Teen Mom’s Lack of Social Capital
• Studies continue to find that children of socio-economically
disadvantaged mothers in general, not just among teenage
mothers, affects the child’s development in a similar way.
• A teen mother’s lack of socio-economic resources when
compared to age of the mother at the birth of her child is
more of a detrimental factor in a child’s development of
problem behavior than age of the adolescent mother.
• Although this does not eliminate the obvious affect of
development and immaturity, a mother’s lack of resources
increases the risks to her and her child more than an older
more mature adolescent mother (Harden, 2007).
Adverse Environments and Genetic Liabilities
• For example, Rutter (2005) and others suggest that there is a passive gene
influence at play that can increase the risk of adolescent pregnancy (passive
rGE). He reasons and statistical evidence supports that “Many of the risks
deriving from adverse experiences are reliant on nature–nurture interplay”
(p. 3).
• In other words, this genetic explanation suggests that an adolescent girl’s
environmental exposure is related to her genetic liabilities.
• In several studies, two sisters, one who gave birth as a teenager and the
other who delays childbearing were compared on socio-demographic and
child development characteristics.
• Among these twins, their age at the birth of their child was statistically less
important than the mother’s lack of socio-economic resources in terms of
increased risk for her child developing behavioral problems regardless of
her age when she gave birth.
• Age did not matter when adequate resources were available to the mother
and her child(ren).
The Gene-Environment Interplay
• Several other biological factors are also related to
adolescent pregnancy risk.
• Timing of pubertal development, hormone levels, and genes
are related to adolescent pregnancy risk because of their
association with the age of first sexual intercourse.
• Among girls, the timing of menarche is a corollary of
female biology, inherited genes and environmental
exposure.
• The most common environmental factor affecting
menarcheal age of onset is nutrition. A sufficient body
mass index of about 17% body fat is required for menarche
to begin.
• Puberty takes place over a two to three year time frame.
Body Mass Index
• While sufficient body mass is needed for menarche
to begin, obesity is strongly associated with girls
reaching menarche at a significantly earlier age than
girls within a normal weight range.
• The report by Bau and associates (2009) is
representative of the line of research. In the Bau
study, girls who were overweight started menarche
at 12.5 years of age, while girls within a normal
weight range started at age 12.9. Underweight girls
started much later at 13.7 years of age. The body
weight for all girls was similar irrespective of age
and height (Bau, 2009).
Sexual Behavior is the most Proximal
Determinant of Fertility
• What we do know about adolescent sexual
behavior, which is of important to our
understanding of adolescent pregnancy is that
substantial variation in human sexual and
reproductive behaviors is inherited.
• Explained by evolutionary theory, genetics has a
major influence on sexual behavior because sexual
behavior is the most proximal determinant of
fertility; the evolutionary process by which genic
reproduction is modified or maintained.
26
The Genetic Influence
• Subsequently, what is most striking about the genetic
influence on early fertility is that it accounts for over
50% of the variation in early fertility.
• A number of twin studies have shown that twins
(monozygotic twins or fertility-related phenotypes) are
statistical similar in the ages of menarche, first sex,
desired age of marriage and desired age to have
children indicating that genetic differences between
individual girls account for population variation in
sexual timing (Aragona, 2006; Bailey et al. 2000;
Dunne et al. 1997; Lyons et al. 2004; Martin et al.
1977; Rowe 2002; Waldron 2004).
The Genetic Influence and Sexual and
Reproductive Services Provided Children
• These finding are important when providing sexual and
reproductive services to young girls.
• Incorporating an understanding of genetic influences will
facilitate the design and delivery of needed services.
• The finding are also troubling, however, because the social
and emotional cost borne by adolescent girls when genetic
influences are ignored.
• Costs that too often result in a negative life trajectory for
the girls and their children (Kohler, Rodgers &
Christensen, 2002).
28
The Belsky-Draper Ho
• One of the controversies that erupted in the 1980s was
the differential in age between African American and
Caucasus girls becoming pregnant in the U. S.
• Conservatist where claiming that a break down in
traditional catholic sexual morals among African
American girls in the U. S. had resulted in the African
American girls becoming pregnant earlier and giving
birth more often than Caucasus girls.
• Rather, Belsky and colleagues (1991; Belsky, 1997)
argued that the early family environment, including the
infant-parent attachment relationship, conveys to
children the risks and uncertainties they are likely to
encounter in their lifetimes.
The Belsky-Draper Ho (cont.)
• According to Belsky, evolutionary theory would predict that this type
of information adaptively regulates psychological, behavioral, and
reproductive development, either toward a mutually beneficial
orientation to interpersonal relations or toward an opportunistic,
advantage-taking point of view.
• These orientations affect mating behavior, pair bonding, and parental
investment;
• They are also responsible for earlier or later sexual debut, unstable or
stable relationships with intimate partners, and a quantity or quality
approach to children and parenting. It was theorized that these
divergent developmental trajectories result from an evolutionary
response that fit the organism to the environment in ways that enhance
reproductive success—or at least did so in the environments of
evolutionary adaptation.
30
A Different Evolutionary Explanation
• There are several serious flaws in the Belsky-Draper hypothesis.
• The most obvious is that the primary worldwide threat to adolescent
fertility is inadequate nutrition. In such cases the evolutionary
response is to fit the organism to the environment in ways that delay
puberty and reduce reproductive success until adequate nutrition is
available.
• How does an evolutionary response explain precious puberty among
African American girls.
• A major evolutionary strategy for survival is to increase one’s
individual value. For females, when the opportunity to increase social
capital is limited and reproductive strategies are the only option
available to African American girls, teen pregnancy rates will be high
among African American girls. Much like they were between the
1950s and the 1970s in the US.
31
Sexual Education for Young Children
• So how can we utilize our knowledge of evolutionary theory and
genetics? For one we can address the question of, “How young
is too young to begin sexual education?”
• This is an honest question given our historical context and the
lack of sexual education in the lives most people today.
• The answer is that sexual development begins at birth and
continues throughout life. Sexual education needs to be aligned
with a child’s sexual development.
• Just like we teach and educate our child from the time of their
birth the individual behaviors and skills needed to prosper and
succeed in life; we need to educate children about their bodies
and about behaviors that are appropriate and emotionally
fulfilling and inappropriate and that could be harmful.
• If for no other reason, children need sexual knowledge to better
able protect themselves from adults in a highly sexualized global
culture.
Sexual Education and Opportunity
• In addition to sexual education starting at birth,
opportunity is the most effective intervention for
preventing and reducing teenage pregnancy. Moreover,
opportunity drives aspiration.
• If you want to know what has caused the great reduction
worldwide of teen pregnancy, look at the inverse
correlation between the increase in all types of
opportunities for girls and women since the 1970s in the
US and the 1990s world wide.
• Look at the widespread growth of the feminist movement
in the U.S. and worldwide between 1970 and 2010.
Thanks for listening.